Osteotomy systems and techniques for treating metatarsal misalignment

Abstract

Systems, devices, and techniques can be used to perform an osteotomy on a bone of a foot, to realign a cut bone portion relative to an adjacent bone portion, and/or to fixate a moved position of the cut bone portion relative to the adjacent bone portion for fusion. In some examples, the disclosed devices and techniques can be used as part of a metatarsal correction procedure in which a metatarsal is treated to correct a bunion deformity.

1 . An intramedullary implant insertion and positioning instrument, the instrument comprising:
 a body configured to releasably connect to an intramedullary implant having a stem portion insertable into a first metatarsal portion and a plate portion positionable against a second metatarsal portion; and   a bone positioning device operatively connected to the body, the bone positioning device being configured to apply a force between the body and a bone portion underlying the body.   
     
     
         2 . The instrument of  claim 1 , wherein the bone positioning device is configured to apply the force between the body and the bone portion underlying the body to cause the second metatarsal portion to move relative to the first metatarsal portion. 
     
     
         3 . The instrument of  claim 2 , wherein the bone positioning device is configured to apply the force between the body and the bone portion underlying the body to cause the second metatarsal portion to move in a transverse plane relative to the first metatarsal portion for treating a bunion deformity. 
     
     
         4 . The instrument of  claim 2 , wherein the bone positioning device is configured to apply the force in a direction generally perpendicular to a length of the intramedullary implant, when the intramedullary implant is releasably connected to the body. 
     
     
         5 . The instrument of  claim 1 , wherein:
 the bone positioning device comprises a shaft; and   the shaft is angled at an acute angle relative to a length of the intramedullary implant, when the intramedullary implant is releasably connected to the body.   
     
     
         6 . The instrument of  claim 1 , wherein:
 the body extends from a first end to a second end;   the bone positioning device defines a contact surface positioned extending beyond the second end of the body; and   the bone positioning device is operable to move the contact surface relative to the body.   
     
     
         7 . The instrument of  claim 6 , wherein the contact surface is carried on an end of a shaft that is configured to translate relative to the body. 
     
     
         8 . The instrument of  claim 1 , wherein:
 the body extends from a first end to a second end;   the body is configured to releasably connect to the intramedullary implant with the plate portion of the intramedullary implant positioned closer to the first end of the body than the second end of the body and the stem portion of the intramedullary implant positioned closer to the second end of the body than the first end of the body; and   the contact surface of the bone positioning device is positioned offset from and beyond an end of the stem portion of the intramedullary implant.   
     
     
         9 . The instrument of  claim 8 , wherein the bone positioning device comprises an actuator operable to move the contact surface relative to the body. 
     
     
         10 . The instrument of  claim 1 , wherein the bone positioning device comprises a first bone positioning device configured to move the second metatarsal portion in a transverse plane, and further comprising a second bone positioning device operatively connected to the body and configured to move the second metatarsal portion in a frontal plane. 
     
     
         11 . The instrument of  claim 1 , wherein the body is configured to releasably connect to the intramedullary implant with a longitudinal axis of the intramedullary implant positioned generally parallel to and offset from a longitudinal axis of the body. 
     
     
         12 . The instrument of  claim 1 , wherein the body configured to releasably connect to the intramedullary implant with the stem portion of the intramedullary implant projecting away from the body and a bone contact surface of the plate portion of the intramedullary implant facing outwardly from the body. 
     
     
         13 . The instrument of  claim 12 , wherein the bone positioning device is configured to apply the force between the body and the bone portion underlying the body to cause the bone contact surface of the plate portion to push again a surface of the second metatarsal portion, when the intramedullary implant is releasably connected to the body and the stem portion of the intramedullary implant is inserted into the first metatarsal portion. 
     
     
         14 . The instrument of  claim 1 , further comprising an implant attachment member operatively connected to the body, the implant attachment member being configured to releasably connect to the intramedullary implant. 
     
     
         15 . The instrument of  claim 14 , wherein the implant attachment member comprises an attachment rod configured to threadingly engage the intramedullary implant. 
     
     
         16 . The instrument of  claim 15 , wherein the body comprises a hook configured to wrap at least partially about a thickness of the intramedullary implant, when the intramedullary implant is releasably connected to the body. 
     
     
         17 . The instrument of  claim 1 , wherein the body defines a screw insertion aperture that is positioned to be co-axially aligned with a fixature aperture of the intramedullary implant, when the intramedullary implant is engaged with the implant attachment member. 
     
     
         18 . The instrument of  claim 17 , wherein the screw insertion aperture comprises a first screw insertion aperture positioned to be co-axially aligned with a first fixation aperture extending through the stem portion of the intramedullary implant and a second screw insertion aperture positioned to be co-axially aligned with a second fixation aperture extending through the plate portion of the intramedullary implant. 
     
     
         19 . The instrument of  claim 17 , further comprising a detachable guide body couplable to the body, wherein:
 the screw insertion aperture defined by the body comprises a screw insertion aperture positioned to be co-axially aligned with a fixation aperture extending through the stem portion of the intramedullary implant; and   the detachable guide body comprises a screw insertion aperture positioned to be co-axially aligned with a fixation aperture extending through the plate portion of the intramedullary implant.   
     
     
         20 . The instrument of  claim 1 , wherein the first metatarsal portion is a proximal metatarsal portion, the second metatarsal portion is a distal metatarsal portion, and the bone portion underlying the body is the proximal metatarsal portion. 
     
     
         21 . A method comprising:
 cutting a metatarsal bone of a foot into a first metatarsal portion and a second metatarsal portion;   inserting a stem portion of an intramedullary implant into the first metatarsal portion and positioning a fixation aperture extending through a plate portion of the intramedullary implant overlying the second metatarsal portion;   using a bone positioning device releasably connected to the intramedullary implant to move the second metatarsal portion relative to the first metatarsal portion in at least one plane; and   inserting a fixation member through the fixation aperture extending through the plate portion of the intramedullary implant and into the second metatarsal portion to fixate a moved position of the second metatarsal portion relative to the first metatarsal portion.   
     
     
         22 . The method of  claim 21 , wherein:
 the bone positioning device comprises an intramedullary implant insertion and bone positioning instrument;   inserting the stem portion of an intramedullary implant into the first metatarsal portion comprises, with the intramedullary implant releasably connected to the intramedullary implant insertion and bone positioning instrument, moving the intramedullary implant insertion and bone positioning instrument to insert the stem portion of the intramedullary implant into the first metatarsal portion; and   positioning the fixation aperture of the intramedullary implant overlying the second metatarsal portion comprises, with the intramedullary implant releasably connected to the intramedullary implant insertion and bone positioning instrument, moving the intramedullary implant insertion and bone positioning instrument to position the fixation aperture of the intramedullary implant overlying the second metatarsal portion.   
     
     
         23 . The method of  claim 22 , wherein:
 moving the intramedullary implant insertion and bone positioning instrument to insert the stem portion of the intramedullary implant into the first metatarsal portion comprises inserting the stem portion of the intramedullary implant at an angle relative to a shaft of the first metatarsal portion; and   moving the intramedullary implant insertion and bone positioning instrument to position the fixation aperture of the intramedullary implant overlying the second metatarsal portion comprises pushing the plate portion of the intramedullary implant against a medial surface of the second metatarsal portion to (i) move the second metatarsal portion laterally relative to the first metatarsal portion and (ii) reduce the angle of the stem portion of the intramedullary implant relative to the shaft of the first metatarsal portion.   
     
     
         24 . The method of  claim 21 , wherein using the bone positioning device releasably connected to the intramedullary implant to move the first metatarsal portion relative to the second metatarsal portion in at least one plane comprises applying a force between a contact surface of the bone positioning device and a bone portion underlying the contact surface. 
     
     
         25 . The method of  claim 24 , wherein the bone portion underlying the contact surface is the first metatarsal portion. 
     
     
         26 . The method of  claim 21 , wherein using the bone positioning device releasably connected to the intramedullary implant to move the first metatarsal portion relative to the second metatarsal portion in at least one plane comprises applying a force to move the second metatarsal portion in a transverse plane for treating a bunion deformity. 
     
     
         27 . The method of  claim 21 , wherein using the bone positioning device releasably connected to the intramedullary implant to move the first metatarsal portion relative to the second metatarsal portion in at least one plane comprises applying a force in a direction generally perpendicular to a length of the intramedullary implant. 
     
     
         28 . The method of  claim 21 , wherein using the bone positioning device to move the second metatarsal portion relative to the first metatarsal portion in at least one plane comprises shifting the second metatarsal portion laterally in a transverse plane and rotating the second metatarsal portion in a frontal plane. 
     
     
         29 . The method of  claim 21 , wherein:
 the bone positioning device comprises a body extending from a first end to a second end, a contact surface positioned extending beyond an end of the intramedullary implant, and a shaft operatively connected to the contact surface; and   using a bone positioning device releasably connected to the intramedullary implant to move the second metatarsal portion relative to the first metatarsal portion in at least one plane comprises moving the shaft relative to the body to move the contact surface against an underlying bone portion.   
     
     
         30 . The method of  claim 21 , wherein the first metatarsal portion is a proximal metatarsal portion and the second metatarsal portion is a distal metatarsal portion.